GLASS IONOMERS

Charles W. Wakefield, DDS, MAGD,ABGD, FICD, FACD

Professor and
Director, AEGD Residency
Baylor Collee of Dentistry ! "AM#$SC
Dallas, "e%as
c&akefield'(cd.ta)hsc.ed*
Objectives
+. "o *nderstand the ,*r,ose and ad-antaes (ehind the *se of lass iono)ers
.. "o de-elo, a &orkin kno&lede of the e-ol*tion, de-elo,)ent and che)istry of lass
iono)ers.
/. "o *nderstand the ,ro,erties and clinical a,,lications of lass iono)ers in order to *se the)
in a,,ro,riate clinical sit*ations.
0. "o learn ho& to ,ro,erly inter,ret infor)ation on lass iono)ers, resin reinforced lass
iono)ers and co),o)ers in order to select the )aterial (est s*ited for clinical *se.
1. "o de-elo, hands2on kno&lede of the clinical )ani,*lation of -ario*s lass iono)er
)aterials.
Evolution
Wilson 3 4ent, Enland, +56+
Co)(ined silicate ce)ent li7*id and ,olycar(o%ylate ce)ent ,o&der
First ,rod*ct 2 ASPA 8 Al*)ino Silica Polyacrylic Acid
Components
Powder
2 CaF., Si9., Al.9/, A+P90, AlF/, :aF
2 or . . . Al*)inofl*orosilicate lass and fl*oride fl*%
Liquid
2 Polyacrylic acid 2 ,ro(le) &ith elation
2 Itaconic acid 2 ,re-ents elation, ,rolons shelf life, i-es sta(ility
2 Maleic acid 2 C99$ ro*,s
2 "artaric acid 2 ,rolons &orkin ti)e
2 Water 2 increases settin rate
+
!brid Gl"ss Ionomers # $RRGI%s & RMGI%s'
2 A)ines, ,ero%ides for a*to c*re
2 Ca),hor7*inone for ;<C
2 BIS2GMA
(ormul"tions
2 !drous
2 Polyacid in li7*id. $ihest -iscosity. $ihest ,$. Fastest initial set. <o&est
sol*(ility. Most (ioco),ati(le.
2 $ihest -iscosity
2 An)!drous
2 Polyacid free=e dried in ,o&der. >*st add &ater. <on shelf life. <o&est ,$.
Slo&est initial set. <o&est -iscosity. So)e (ioco),ati(ility ,ro(le)s.
2 E%? 4etac Ce), C@2Pl*s and so)e ,o&der2li7*id syste)s
2 Semi)!drous
2 Polyacid in ,o&der and li7*id. Inter)ediate -iscosity. Inter)ediate ,$.
Inter)ediate ,ro,erties.
2 E%? 4etac Ce) Ma%ica, and )ost enca,s*lated syste)s
Gl"ss Ionomer *ses
$ih caries
Class ;As, a(fractions
Protected Class IIIAs
<iners, (ases
<*tin aents B ce)ents 2 C3B, orthodontics, endodontics
B*ild*,s, cores C(ad choiceD
Marin re,airs
Sealants C(ad choiceD
Bondin aents
Gl"ss Ionomer Adv"nt"+es
Che)ical (ond to dentin, ena)el, ce)ent*)
Bioco),ati(le to ,*l,
Fl release B Fl recharea(le
Mini)al ,oly)eri=ation shrinkae
More ,redicta(le )arinal seal
Coefficient of ther)al e%,ansion B contraction
Mod*l*s of elasticity
Esthetics i),ro-in
Gl"ss Ionomer ,is"dv"nt"+es
"echni7*e sensiti-e
9,a7*e
.
#nesthetic 2 too fe& shades
<o& (ond strenth
<o& co),ressi-e strenth
Gl"ss Ionomer Settin+ Re"ction
Clinical set 2 Ca
EE
2 12+F )in*tes
Chelation &ith Ca in tooth
Mat*ration 2 Al
EEE
2 .020G ho*rs
Increase in strenth 2 Internal ion e%chane 2 Silica ,hase Infinity
Mi% faster than instr*ctions
Protect d*rin settin
;<C 2 &ait to ,olish
-"ter is essential for acid2(ase lass iono)er reaction
.oot) Prep"r"tions
Mechanical retention and (*lk ca-os*rface )arins not re7*ired CContro-ersialD
S)ear layer ,resence necessary
2 Gro*nd ena)el and dentin, collaen, sali-a, )icrooranis)s
2 "hickness +21 )icrons
2 Adherence 2 .20 MPa
Partial re)o-al of s)ear layer
2 "*(*les re)ain occl*ded ! is one reason ,osto, sensiti-ity is )ini)al
2 Polyacrylic acid +FH, .FH, .1H, 0FH CIConditionerJD
2 Scr*((in action
2 Rinse, do not desiccate
Place)ent of convention"l lass iono)er
2 Co-er &ith -arnish, co),osite sealant or (ondin aent i))ediately
2 Wait for clinical set
Marinate, ,olish, ,rotect &ith (ondin aent or co),osite sealant
,evelopment
Convention"l 2 liners, restorati-es, l*tin aents
2 Restorati-es? 4etac Fil, 4etac Sil-er, 4etac Molar, 4etac Molar Easy)i%,
F*Ki I@ GP, "riae C6 @ the Fl releaseD, F*Ki I@ GP E%tra CL @ the Fl releaseD
Che)Fil Rock
Resin Rein/orced Gl"ss Ionomers $RRGI' 2 increased ,o,*larity of Gl *se
2 "ri2C*re ,rod*cts 2 12+FH resin co),onent Ca*toc*re and ;<CD ,l*s the acid2
(ase lass iono)er reaction C4etac :ano and F*Ki II <CD
2 Syste) )*st contain w"ter for lass iono)er reaction to occ*r
2 Many resin syste)s are anhydro*s 2 lass iono)er is K*st filler in these
2 RRGIAs 2 ha-e acid2(ase reaction and a resin c*re
2 First *sed as liner, then restorati-e, then l*tin aent, then sealant, then core
)aterial, then (ondin aent
2 RRGI Restor"tive M"teri"ls 2 ,i)ents i),ro-ed shade ,ossi(ilities
/
2 Characteristics of IResin ModifiedBReinforcedJ Glass Iono)ers
2 faster, finish sooner
2 (etter esthetics than con-entional lass iono)er
2 hiher strenth than con-entional lass iono)er
2 ad-antaes of lass iono)er
2 lo&er strenth than co),osite
2 less esthetic than co),osite
2 ,oly)eri=ation shrinkae increase o-er con-entional GIAs
2 E%cellent restorati-es for decid*o*s teeth and for ,atients &ith
co),ro)ised 7*alityB7*antity of sali-a
2 0uildup )aterial 2 addition of )etal C*s*ally AD and ,rocess of sinterin
2 ,ro,erties *nchaned
2 R9, a(rasion resistantMM
2 4etac Sil-er, Miracle Mi%, $i Dense "C
2 :ot reco))ended
2 Resin Rein/orced Gl"ss Ionomer lutin+ "+ents
2 Co)(ine strenth of resin ce)ents &ith lass iono)er ad-antaes
2 F*Ki Pl*s, Rely@ <*tin Pl*s, F*KiCEM, F*Ki Ce) A*to)i%
Compomers
2 Polyacid )odified co),osite resin restorati-e CDyract AP, Co),olass F,
F2.FFFD
2 Pri)ary adhesion is (y resin (ondin aent
2 :o &ater in syste)
2 Basically a co),osite &ith ,olyacid and lass iono)er filler added
2 Clai)ed to ha-e hydro,hillic )ono)ers that a(sor( &ater later
2 Restorati-es? Dyract AP, Co),olass F, $ytac, F2.FFF, Elan, Freedo),
Dyract Flo&, Co),olass Flo&, 9)eaFlo&, etc.
2 <*tin aents? Princi,le, Pro"ecCEM C*ns*ccessf*l, e%,ansionD
2 I#nder the conditions of this in2-i-o trial, &e fo*nd no ,re-enti-e effect of
fl*oride2realeasin co),o)er co),ared &ith a)ala).J, "rachten(er, F.,
J Dent Res, March .FF5
,entin 0ondin+ A+ents
2 Direct (ondin of co),osite to dentin and ena)el
2 Sealin of hy,ersensiti-e dentin and ce)ent*)
2 F*Ki Bond <C 2 Filled, acid2(ase reaction Cis really F*Ki II <CD
or F<2Bond CGio)er, Shof*D
2 Conditioner 2 .FH PAA, /H AlCl, Ena)el dentin etch
1Condens"ble2 or 1P"c3"ble2 Gl"ss Ionomers
2 Increased P?<
2 S)aller ,article si=e, increased -iscosity
2 Said to Icondense like a)ala)J
2 4etac Molar, F*Ki I@ GP, $i Dense "C, Ri-a Self C*re
1PRG Giomers2
# Pre Reacted Glass iono)ers *sed as filler
2 :e&er ty,e of RRGI
0
2 I))ediate and s*stained fl*oride release
2 :o deradation of filler )atri% o-er ti)e
2 E%a),le? Bea*tifil CShof*D and F< Bond
IMaterials ha-e (een )arketed as Nlass iono)er s*(stit*tesA, and it has e-en (een
clai)ed that so)e of the) ha-e Nall the che)istry of a lass iono)er alon &ith the
esthetics of a co),osite resinA &hich, of co*rse, is che)ically i),ossi(leJ Mo*nt, G.,
Quint Int, 9ct +556
Clinic"l Applic"tions
+. Liners
Liner tec)nique
2 :o dentin conditionin
2 Ca9$ if )echanical ,*l, e%,os*re is less than F.1 )) if desired
2 Co-er and seal Ca9$ &ith RRGI liner
2 Mini)i=e dentinal co-erae &ith RRGI
2 Etch, *se (ondin syste)
2 Place restoration
Liner Comments
2 Gi-es fl*oride *nder restoration
2 Co-ers -al*a(le dentin needed for (ondin
2 E%cellent liner *nder a)ala)s
2 Mini)i=e *se *nder co),osites
2 Adhesi-e strenth reater than cohesi-e strenth
- Stress a(sor(er *nder stiff restorati-es or in a(fractions
Gl"ss Ionomer Liners
2 4etac Bond
2 ;itre(ond
2 F*Ki <inin <C
2 Photac Bond
2 RRGI restorati-es, co),o)ers
.. Restor"tives
.ec)nique
2 Pre,, no (e-el on ce)ent*). Be-el ena)el on Cl ;As
2 Isolate &ith cord if Class ;
2 PAA conditioner. $/P90 etch &ith co),o)ers
2 "hin layer 2 ;<C
2 . )) incre)ents 2 ;<C
2 9-erfill, co-er, ,rotect &ith -arnish or ;<C resin
2 Wait 12+F )in*tes
2 Finish, ,olish
2 F*Ki Coat, Gla=e, Fortify, 9,tiG*ard, Per)aseal, Protect It CGIAs and RRGIAsD
E-en tho*h RRGIAs are liht c*red, the GI reaction )*st still (e ,rotected.
2 Protect for at least .0 ho*rs
1
2 Post2c*re
Addition"l In/orm"tion4
"r*e RRGIAsM Settin )echanis)s?
Pol!meri5"tion Initi"tion
Product Acid#0"se 6LC C)emic"l
F*Ki I@ GP @
4etac2FilBMolar @
4etac2Sil-er @
F*Ki I@ GP E%tra @
"riae @
Geristore @ @
F*Ki II <CCI),D @ @ @
;itre)er @ @ @
Rely@ <*tin @ @
F*Ki Pl*s @ @
Dyract AP @
Co),olass F @
Caries "reat)ent Protocol?
2 Re,air ca-itated lesions ! GIAs, RRGIAs
2 F.+.H C$G .% daily for . &eeks 7 / )onths, then .% daily 7 /26 days )aintenance
2 R% 1 ) ,ilocar,ine /% daily or /F ) ce-i)eline /% daily
2 Fl*oride ! tooth,aste, rinses, -arnishes, trays. Clear Fl -arnishes? ClearShield, 9,al
;arnish, ;anish, Ena)el Pro C&ith ACPD. Fl*oride -arnish 1H :aFl a-aila(le in clear
sol*tion.
2 A)or,ho*s Calci*) Phos,hate CACPD. :o& a-aila(le in *), )ints, tooth,astes as
MI Paste, Clin,ro 1FFF, Re:e&
2 Diet co*nselin, 9$I
2 @ylitol ! *), )ints, tooth,aste, Biotene C%ylitolinfo.co) and %ylitol.co)D
2 PRRAs, sealants
2 Mo*th rinse ! 9asis or Biotene Moist*ri=in Mo*th&ash B 9asis or Biotene
Moist*ri=in Mo*th S,ray
2 Fre7*ent follo&2*,s
2 IGI )aterials ,ro-ide a caries2inhi(itory effect not only thro*h Fl release (*t also
thro*h an acid ne*trali=in a(ility. F*Ki II <C &as the only )aterial that retained a ,$
-al*e of O1.1 in acid sol*tion after +F &eeks.J Itota, Oper Dent, >*lBA* .FF1
Medications that )ay ca*se %erosto)ia?
2 Anore%iant, Antiacne, Antian%iety, AnticholinericBantis,as)odic, Anticon-*lsant,
L
Antide,ressant, Antidiarrhetic, Antihista)ine, Antihy,ertensi-e, Anti2infla))atory
analesic, Antina*seantBantie)etic, Anti,arkinsonian, Anti,sychotic, Bronchodilator,
Deconestant, Di*retic, M*scle rela%ant, :arcotic analesic, Sedati-es
Additional Info?
2 I"he 1FFF ,,) Fl a-e increased re)inerali=ation and decreased de)inerali=ation
&hen co),ared &ith traditional +1FF ,,) Fl in ad-anced s*(s*rface lesions.J
C"en Cate, >, J Dent Res, 9ct .FFGD
2 "he )ost effecti-e )aterial in red*cin cario*s areas &as GIC O Fl -arnish O Fl sealant
O Sealants. "he re)inerali=ation effect &ith GIC and Fl -arnish also inhi(ited
de)inerali=ation of intact ena)el adKacent to the )aterials.J
C"raiart-orak*l, C, J Dent Res, Mar .FFGD
2 CAMBRA? Caries Manae)ent (y Risk Assess)ent. "he fo*ndation of CAMBRA
lies in identifyin s,ecific disease indicators and risk factors, and concl*din &ith a
risk assess)ent and a stratey for the de-elo,)ent of an indi-id*ali=ed treat)ent
,lan.J, D*ffin, S., Compendium, March .FF5
2 @ylitol? :ot fer)ented (y car(s. Red*ces ,la7*e acc*)*lation. Re)inerali=ation
enhanced. Increases sali-a flo&. Maternal che&in of %ylitol *) res*lted in 5 ! .0
)onth old children ac7*irin stre, )*tans G.G )onths later than the non2%ylitol ro*,.
6